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Ferrari N, Schmidt N, Bae-Gartz I, Vohlen C, Alcazar MAA, Brockmeier K, Dötsch J, Mahabir E, Joisten C. Maternal Exercise during Pregnancy Impacts Motor Performance in 9-Year-Old Children: A Pilot Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1797. [PMID: 38002888 PMCID: PMC10670111 DOI: 10.3390/children10111797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023]
Abstract
The benefits of maternal physical activity during pregnancy are well documented, but long-term effects on the child have been less studied. Therefore, we conducted a pilot follow-up study of a lifestyle intervention during pregnancy that aimed to investigate whether exercise (endurance and strength training) during pregnancy affects motor performance and body composition of children up to 9 years of age, as well as possible influencing factors like brain-derived neurotrophic factor (BDNF) and lifestyle. Eleven mother-child pairs from the intervention and eight mother-child pairs from the control group were included. From birth up to 9 years of age, no differences in body mass index (BMI) or body mass index standard deviation scores (BMI-SDS) were found between the groups. Lifestyle intervention was one of the influencing factors for children's cardiorespiratory endurance capacity and coordination. Moreover, maternal BDNF in the last trimester was significantly associated with running performance, which may be due to better neuronal development. This is the first study evaluating the effects of a lifestyle intervention during pregnancy on the motor performance 9 years after birth. Children's participation in exercise programs over the past 9 years was not continuously recorded and therefore not included in the analysis. Even a cautious interpretation of these results indicates that a healthy lifestyle during pregnancy is essential in promoting child health. Larger studies and randomized control trials are necessary to confirm our results, especially those pertaining to the role of BDNF.
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Affiliation(s)
- Nina Ferrari
- Cologne Center for Prevention in Childhood, Youth/Heart Center Cologne, University Hospital of Cologne, 50937 Cologne, Germany
- Department for Physical Activity in Public Health, Institute of Movement and Neurosciences, German Sport University Cologne, 50933 Cologne, Germany
- Department for Pediatric Cardiology, Heart Center, University of Cologne, 50937 Cologne, Germany
| | - Nikola Schmidt
- Department for Physical Activity in Public Health, Institute of Movement and Neurosciences, German Sport University Cologne, 50933 Cologne, Germany
| | - Inga Bae-Gartz
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, University of Cologne, 50931 Cologne, Germany
| | - Christina Vohlen
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, University of Cologne, 50931 Cologne, Germany
- Department of Pediatric and Adolescent Medicine, Translational Experimental Pediatrics-Experimental Pulmonology, Cologne Excellence Cluster on Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Miguel A Alejandre Alcazar
- Department of Pediatric and Adolescent Medicine, Translational Experimental Pediatrics-Experimental Pulmonology, Cologne Excellence Cluster on Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
- The German Centre for Lung Research (DZL), Institute for Lung Health (ILH), Cardiopulmonary Institute (CPI), University of Giessen and Marburg Lung Centre (UGMLC), Justus-Liebig University Gießen, 35392 Gießen, Germany
| | - Konrad Brockmeier
- Cologne Center for Prevention in Childhood, Youth/Heart Center Cologne, University Hospital of Cologne, 50937 Cologne, Germany
- Department for Pediatric Cardiology, Heart Center, University of Cologne, 50937 Cologne, Germany
| | - Jörg Dötsch
- Cologne Center for Prevention in Childhood, Youth/Heart Center Cologne, University Hospital of Cologne, 50937 Cologne, Germany
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, University of Cologne, 50931 Cologne, Germany
| | - Esther Mahabir
- Comparative Medicine, Center for Molecular Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50931 Cologne, Germany
| | - Christine Joisten
- Cologne Center for Prevention in Childhood, Youth/Heart Center Cologne, University Hospital of Cologne, 50937 Cologne, Germany
- Department for Physical Activity in Public Health, Institute of Movement and Neurosciences, German Sport University Cologne, 50933 Cologne, Germany
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Claiborne A, Jevtovic F, May LE. A narrative review of exercise dose during pregnancy. Birth Defects Res 2023; 115:1581-1597. [PMID: 37735993 DOI: 10.1002/bdr2.2249] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/21/2023] [Accepted: 09/01/2023] [Indexed: 09/23/2023]
Abstract
The current recommendations for prenatal exercise dose align with those from the American College of Sports Medicine; 150 min of moderate intensity every week of pregnancy. However, recent works suggest there may be a dose-dependent beneficial effect for mother and offspring; maternal and offspring health outcomes respond differently to low, medium, and high doses of prenatal exercise. It is, therefore, our aim to summarize the published evidence (years 1950-2023) for five metrics of prenatal exercise training commonly reported, that is, "FITT-V": Frequency (number of sessions), Intensity (metabolic equivalents "METs"), Time (duration of sessions), Type (exercise mode), Volume (exercise MET*mins). The target audience includes clinicians and health care professionals, as well as exercise professionals and physiologists. Data suggest that moderate exercise frequency (3-4 times weekly) appears safe and efficacious for mother and offspring, while there is contradictory evidence for the safety and further benefit of increased frequency beyond 5 sessions per week. Moderate (3-6 METs) and vigorous (>6 METs) intensity prenatal exercise have been shown to promote maternal and offspring health, while little research has been performed on low-intensity (<3 METs) exercise. Exercise sessions lasting less than 1 hr are safe for mother and fetus, while longer-duration exercise should be carefully considered and monitored. Taken together, aerobic, resistance, or a combination of exercise types is well tolerated at medium-to-high volumes and offers a variety of type-specific benefits. Still, research is needed to define (1) the "minimum" effective dose of exercise for mother and offspring health, as well as (2) the maximum tolerable dose from which more benefits may be seen. Additionally, there is a lack of randomized controlled trials addressing exercise doses during the three trimesters of pregnancy. Further, the protocols adopted in research studies should be more standardized and tested for efficacy in different populations of gravid women.
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Affiliation(s)
- Alex Claiborne
- Department of Kinesiology, East Carolina University, Greenville, North Carolina, USA
- Human Performance Laboratory, East Carolina University, Greenville, North Carolina, USA
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina, USA
| | - Filip Jevtovic
- Department of Kinesiology, East Carolina University, Greenville, North Carolina, USA
- Human Performance Laboratory, East Carolina University, Greenville, North Carolina, USA
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina, USA
| | - Linda E May
- Department of Kinesiology, East Carolina University, Greenville, North Carolina, USA
- Human Performance Laboratory, East Carolina University, Greenville, North Carolina, USA
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina, USA
- Department of Obstetrics and Gynecology, East Carolina University, Greenville, North Carolina, USA
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Ding L, Liu J, Zhou L, Xiao X. Maternal Exercise Impacts Offspring Metabolic Health in Adulthood: A Systematic Review and Meta-Analysis of Animal Studies. Nutrients 2023; 15:2793. [PMID: 37375697 DOI: 10.3390/nu15122793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 05/27/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Maternal exercise benefits offspring's metabolic health with long-term repercussions. Here, we systematically reviewed the effects of maternal exercise on offspring obesity outcomes in adulthood. The primary outcome is body weight. The secondary outcomes are glucose and lipid profiles. Two independent authors performed a search in the databases PubMed, EMBASE, and Web of Science. A total of nine studies with 17 different cohorts consisting of 369 animals (two species) were included. Study quality was assessed using the SYRCLE risk of bias. The PRISMA statement was used to report this systematic review. The results showed that maternal exercise contributes to improved glucose tolerance, reduced insulin concentration, and lower total cholesterol and low density lipoprotein levels in adult offspring in mice, which are independent of maternal body weight and offspring dietary condition. Additionally, in rats, maternal exercise leads to a higher body weight in adult offspring, which might be attributed to the high-fat diet of offspring after weaning. These findings further support the metabolic beneficial role of maternal exercise on offspring in adulthood, although the issue of translating the results to the human population is still yet to be addressed.
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Affiliation(s)
- Lu Ding
- Key Laboratory of Endocrinology of National Health Commission, Diabetes Research Center of Chinese Academy of Medical Sciences, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Xin-Hua Xiao, No. 1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing 100730, China
| | - Jieying Liu
- Key Laboratory of Endocrinology of National Health Commission, Diabetes Research Center of Chinese Academy of Medical Sciences, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Xin-Hua Xiao, No. 1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing 100730, China
- Department of Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Liyuan Zhou
- Key Laboratory of Endocrinology of National Health Commission, Diabetes Research Center of Chinese Academy of Medical Sciences, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Xin-Hua Xiao, No. 1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing 100730, China
| | - Xinhua Xiao
- Key Laboratory of Endocrinology of National Health Commission, Diabetes Research Center of Chinese Academy of Medical Sciences, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Xin-Hua Xiao, No. 1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing 100730, China
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Beetham KS, Spathis JG, Hoffmann S, Brown WJ, Clifton V, Mielke GI. Longitudinal association of physical activity during pregnancy with maternal and infant outcomes: Findings from the Australian longitudinal study of women's health. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221142357. [PMID: 36560920 PMCID: PMC9793022 DOI: 10.1177/17455057221142357] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Physical activity has known benefits during pregnancy; however, the optimum volume of physical activity through the different stages of pregnancy is not well known. OBJECTIVES The aims of this study were to investigate the associations of physical activity volume in pregnant women in each trimester of pregnancy with maternal and infant outcomes. DESIGN The study involved 1657 pregnant women from the Australian Longitudinal Study on Women's Health, who completed surveys from 2006 to 2012 (aged 28-39 years). METHODS Women reported being in either the first, second or third trimester of pregnancy. Women were grouped into four groups according to their self-reported physical activity during pregnancy: (1) Nil (0-<33.3 MET.min/week), (2) Low (33.3-<500 MET.min/week), (3) Moderate (500-<1000 MET.min/week) and (4) High (⩾1000 MET.min/week). Women who reported their physical activity during pregnancy completed a survey within three years after the birth, relating to outcomes associated with pregnancy and childbirth (gestational diabetes, hypertension, and antenatal depression and anxiety) and infant outcomes (birthweight and prematurity). RESULTS There was no association of physical activity in any trimester with infant birthweight, prematurity, gestational diabetes, hypertension or antenatal depression. Antenatal anxiety was less prevalent in women who reported low (1.7%) or moderate (1.1%) physical activity than in those who reported no activity (4.7%; p = 0.01). CONCLUSION Different amounts of physical activity during pregnancy were not associated with the measured adverse health outcomes. However, low and moderate amounts of physical activity were associated with reduced incidence of antenatal anxiety.
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Affiliation(s)
- Kassia S Beetham
- School of Behavioural and Health
Sciences, Australian Catholic University, Brisbane, QLD, Australia,School of Exercise and Nutrition
Sciences, Deakin University, Geelong, VIC, Australia,Kassia S Beetham, School of Behavioural and
Health Sciences, Australian Catholic University, 1100 Nudgee Road, Banyo,
Brisbane, QLD, 4014, Australia.
| | - Jemima G Spathis
- School of Behavioural and Health
Sciences, Australian Catholic University, Brisbane, QLD, Australia
| | - Samantha Hoffmann
- School of Exercise and Nutrition
Sciences, Deakin University, Geelong, VIC, Australia
| | - Wendy J Brown
- School of Human Movement and Nutrition
Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Vicki Clifton
- Mater Research and Translational
Research Institute, Brisbane, QLD, Australia
| | - Gregore I Mielke
- School of Public Health, The University
of Queensland, Brisbane, QLD, Australia
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Goławski K, Wojtyła C. Impact of Physical Activity of Pregnant Women on Obstetric Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912541. [PMID: 36231839 PMCID: PMC9564719 DOI: 10.3390/ijerph191912541] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/22/2022] [Accepted: 09/29/2022] [Indexed: 05/27/2023]
Abstract
Regular and well-planned physical activity (PA) has a positive impact on pregnancy outcomes. In this study, we determine the impact of the PA of pregnant women on the occurrence of certain pregnancy outcomes, such as type of labor, duration of pregnancy, and birthweight. The study is based on the results of a Polish national survey performed between 2011 and 2017 on a group of 9170 women. The Pregnancy Physical Activity Questionnaire (PPAQ) was used to estimate the PA of pregnant women. Light intensity PA accounts for the largest proportion of women's total energy expenditure. Increase in women's total energy expenditure was associated with an increase in the birthweight of a child. A similar relationship was observed in the case of light and moderate PA. Vaginal birth was more common among women with higher total energy expenditure. Mothers of preterm children showed lower energy expenditure for each type of PA compared to term pregnancies. There was also a correlation between moderate and vigorous PA and low birthweight. Our study indicates that PA undertaken by pregnant women has a positive impact on pregnancy outcomes.
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Affiliation(s)
- Ksawery Goławski
- Department of Obstetrics and Gynecology, Medical University of Warsaw, 02-015 Warsaw, Poland
| | - Cezary Wojtyła
- International Prevention Research Institute—Collaborating Centre, Calisia University, 16 Kaszubska St., 62-800 Kalisz, Poland
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Seneviratne SN, Rajindrajith S. Fetal programming of obesity and type 2 diabetes. World J Diabetes 2022; 13:482-497. [PMID: 36051425 PMCID: PMC9329845 DOI: 10.4239/wjd.v13.i7.482] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/18/2021] [Accepted: 06/03/2022] [Indexed: 02/06/2023] Open
Abstract
The prevalence of obesity and type 2 diabetes mellitus has increased rapidly over the past few decades, and prevention efforts have not been successful. Fetal programming involves the earliest stage of obesity development, and provides a novel concept to complement other strategies for lifelong prevention of obesity and type 2 diabetes mellitus. The World Health Organization now advocates a life-course approach to prevent/control obesity, starting with pre-conceptional and antenatal maternal health. Maternal overnutrition, gestational diabetes mellitus and excessive gestational weight gain lead to fetal overgrowth, and "programs" the offspring with an increased risk of obesity and type 2 diabetes mellitus in childhood and adulthood. This review summarizes current data on fetal programming of obesity and type 2 diabetes mellitus including potential causative factors, mechanisms and interventions to reduce its impact.
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Affiliation(s)
| | - Shaman Rajindrajith
- Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo 08, Sri Lanka
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Chen Y, Ma G, Hu Y, Yang Q, Deavila JM, Zhu MJ, Du M. Effects of Maternal Exercise During Pregnancy on Perinatal Growth and Childhood Obesity Outcomes: A Meta-analysis and Meta-regression. Sports Med 2021; 51:2329-2347. [PMID: 34143412 DOI: 10.1007/s40279-021-01499-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Perinatal growth abnormalities program susceptibility to childhood obesity, which is further exaggerated by maternal overweight and obesity (MO) during pregnancy. Exercise is highly accessible, but reports about the benefits of maternal exercise on fetal growth and childhood obesity outcomes are inconsistent, reducing the incentives for pregnant women to participate in exercise to improve children's perinatal growth. OBJECTIVE This systematic review and meta-analysis aims to establish evidence-based efficacy of exercise in mothers with normal weight (MNW) and MO during pregnancy in reducing the risks of perinatal growth abnormalities and childhood obesity. In addition, the impacts of exercise volume are also assessed. METHODS The PubMed, ScienceDirect, Web of Science, and Cochrane Library databases were searched from inception to February 15, 2020. We included randomized controlled trials with exercise-only intervention or exercise with other confounders in pregnant MNW (body mass index, BMI 18.5-24.9 kg/m2) and MO (BMI ≥ 25 kg/m2), which were further subgrouped in the meta-analysis. Primary outcomes included birth weight, preterm birth, small for gestational age (SGA), large for gestational age (LGA), infant and childhood weight, and childhood obesity. A linear meta-regression analysis was also used to explore the effects of exercise volume on outcomes. RESULTS 99 studies were included in the meta-analysis (n = 596,876), and individual study quality ranged from fair to good according to the Newcastle-Ottawa scale assessment. Exercise only interventions in MNW reduced preterm birth by 15% (26 studies, n = 76,132; odds ratio [OR] 0.85; 95% CI 0.72, 1.01; I2 = 83.3%), SGA by 17% (33 studies, n = 92,351; OR 0.83; 95% CI 0.71, 0.98; I2 = 74.5%) and LGA by 17% (29 studies, n = 84,310; OR 0.83; 95% CI 0.74, 0.95; I2 = 60.4%). Exercise only interventions in MO reduced preterm birth by 33% (2 studies, n = 3,050; OR 0.67; 95% CI 0.70, 0.96; I2 = 0%), SGA by 27% (8 studies, n = 3,909; OR 0.73; 95% CI 0.50, 1.05; I2 = 40.4%) and LGA by 55% (9 studies, n = 81,581; OR 0.45; 95% CI 0.18, 1.11; I2 = 98.3%). Exercise only interventions in MNW reduced childhood obesity by 53% (3 studies, n = 6,920; OR 0.47; 95% CI 0.36, 0.63; I2 = 77.0%). However, no significant effect was observed in outcomes from exercise confounders in either MNW or MO. In the meta-regression, the volume of exercise-only intervention in MNW was negatively associated with birth weight, greatly driven by volumes more than 810 metabolic equivalents (MET)-min per week. Other outcomes were not associated with exercise volume. CONCLUSIONS This systematic review and meta-analysis suggests that exercise during pregnancy in both MNW and MO safely and effectively reduce the risks of preterm birth, SGA, and LGA. Furthermore, MNW exercise also reduces the risk of childhood obesity. Overall, regardless of prepregnancy BMI, maternal exercise during pregnancy provides an excellent opportunity to mitigate the high prevalence of adverse birth outcomes and childhood obesity.
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Affiliation(s)
- Yanting Chen
- Center for Reproductive Biology, School of Molecular Biosciences, Washington State University, Pullman, WA, 99164, USA.,Nutrigenoimics and Growth Biology Laboratory, Department of Animal Sciences, Washington State University, Pullman, WA, 99164, USA
| | - Guiling Ma
- College of Animal Science and Technology, Yangzhou University, Yangzhou, 225009, People's Republic of China
| | - Yun Hu
- College of Animal Science and Technology, Yangzhou University, Yangzhou, 225009, People's Republic of China
| | - Qiyuan Yang
- Department of Molecular, Cell and Cancer Biology, University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | - Jeanene M Deavila
- Center for Reproductive Biology, School of Molecular Biosciences, Washington State University, Pullman, WA, 99164, USA.,Nutrigenoimics and Growth Biology Laboratory, Department of Animal Sciences, Washington State University, Pullman, WA, 99164, USA
| | - Mei-Jun Zhu
- School of Food Science, Washington State University, Pullman, WA, 99164, USA
| | - Min Du
- Center for Reproductive Biology, School of Molecular Biosciences, Washington State University, Pullman, WA, 99164, USA. .,Nutrigenoimics and Growth Biology Laboratory, Department of Animal Sciences, Washington State University, Pullman, WA, 99164, USA.
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Beetham KS, Giles C, Noetel M, Clifton V, Jones JC, Naughton G. The effects of vigorous intensity exercise in the third trimester of pregnancy: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2019; 19:281. [PMID: 31391016 PMCID: PMC6686535 DOI: 10.1186/s12884-019-2441-1] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 07/30/2019] [Indexed: 11/19/2022] Open
Abstract
Background Fetal growth is dependent upon utero-placental vascular supply of oxygen and nutrients from the mother and has been proposed to be compromised by vigorous intensity exercise in the third trimester. The aim of this systematic review was to investigate the effects of vigorous intensity exercise performed throughout pregnancy, on infant and maternal outcomes. Methods Electronic searching of the PubMed, Medline, EMBASE, Cochrane Library, Web of Science and CINAHL databases was used to conduct the search up to November 2018. Study designs included in the systematic review were randomised control trials, quasi-experimental studies, cohort studies and case-control studies. The studies were required to include an intervention or report of pregnant women performing vigorous exercise during gestation, with a comparator group of either lower intensity exercise or standard care. Results Ten cohort studies (n = 32,080) and five randomized control trials (n = 623) were included in the systematic review (n = 15), with 13 studies included in the meta-analysis. No significant difference existed in birthweight for infants of mothers who engaged in vigorous physical activity and those who lacked this exposure (mean difference = 8.06 g, n = 8006). Moreover, no significant increase existed in risk of small for gestational age (risk ratio = 0.15, n = 4504), risk of low birth weight (< 2500 g) (risk ratio = 0.44, n = 2454) or maternal weight gain (mean difference = − 0.46 kg, n = 1834). Women who engaged in vigorous physical activity had a small but significant increase in length of gestational age before delivery (mean difference = 0.21 weeks, n = 4281) and a small but significantly reduced risk of prematurity (risk ratio = − 0.20, n = 3025). Conclusions Findings from this meta-analysis indicate that vigorous intensity exercise completed into the third trimester appears to be safe for most healthy pregnancies. Further research is needed on the effects of vigorous intensity exercise in the first and second trimester, and of exercise intensity exceeding 90% of maximum heart rate. Trial registration PROSPERO trial registration CRD42018102109. Electronic supplementary material The online version of this article (10.1186/s12884-019-2441-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kassia S Beetham
- School of Behavioural and Health Sciences, Australian Catholic University, 1100 Nudgee Road, Banyo, Brisbane, Queensland, 4014, Australia.
| | - Courtney Giles
- School of Behavioural and Health Sciences, Australian Catholic University, 1100 Nudgee Road, Banyo, Brisbane, Queensland, 4014, Australia
| | - Michael Noetel
- School of Behavioural and Health Sciences, Australian Catholic University, 1100 Nudgee Road, Banyo, Brisbane, Queensland, 4014, Australia
| | - Vicki Clifton
- Pregnancy and Development, Mater Research Institute-University of Queensland, Translational Research Institute, South Brisbane, Queensland, Australia
| | - Jacqueline C Jones
- Obstetrics and Gynaecology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Geraldine Naughton
- Department of Educational Studies, Macquarie University, Sydney, New South Wales, Australia.,School of Health Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
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Flannery C, Dahly D, Byrne M, Khashan A, McHugh S, Kenny LC, McAuliffe F, Kearney PM. Social, biological, behavioural and psychological factors related to physical activity during early pregnancy in the Screening for Pregnancy Endpoints (Cork, Ireland) cohort study. BMJ Open 2019; 9:e025003. [PMID: 31227527 PMCID: PMC6596951 DOI: 10.1136/bmjopen-2018-025003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The aim of this study was to identify the social, biological, behavioural and psychological factors related to physical activity (PA) in early pregnancy. DESIGN This is a secondary analysis of data from a prospective cohort study. SETTING The study was conducted in Cork, Ireland. PARTICIPANTS Nulliparous women with singleton pregnancies were recruited and then interviewed at 15±1 weeks' gestation. PRIMARY AND SECONDARY OUTCOMES The biopsychosocial model identified factors including social (age), biological (body mass index), behavioural (diet) and psychological (anxiety) at 15±1 weeks' gestation. PA subgroups were identified based on a latent class analysis of their responses to a set of questions about the amount and intensity of activity they were engaging in during the pregnancy. Associations were estimated with multivariable multinomial logistic regression models. RESULTS From a total of 2579, 1774 (69%) women were recruited; ages ranged from 17 to 45 years. Based on a combination of model fit, theoretical interpretability and classification quality, the latent class analyses identified three PA subgroups: low PA (n=393), moderate PA (n=960) and high PA (n=413). The fully adjusted model suggests non-smokers, and consumers of fruit and vegetables were more likely to be in the high PA subgroup (vs low). Women with more than 12 years of schooling and a higher socioeconomic status were more likely to be in the moderate PA subgroup (vs low). CONCLUSION The findings highlight potential links between PA, a low education level and a low socioeconomic background. These factors should be considered for future interventions to improve low PA levels during pregnancy. TRIAL REGISTRATION NUMBER ACTRN 12607000551493.
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Affiliation(s)
- Caragh Flannery
- School of Psychology, Health Behaviour Change Research Group, National University of Ireland Galway, Galway, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - Darren Dahly
- School of Public Health, University College Cork, Cork, Ireland
- Health Research Board, Clinical Research Facility Cork, University College Cork, Cork, Ireland
| | - Molly Byrne
- School of Psychology, Health Behaviour Change Research Group, National University of Ireland Galway, Galway, Ireland
| | - Ali Khashan
- School of Public Health, University College Cork, Cork, Ireland
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
| | - Sheena McHugh
- School of Public Health, University College Cork, Cork, Ireland
| | - Louise C Kenny
- Department of Women’s and Children’s Health, University of Liverpool School of Life Sciences, Liverpool, UK
| | - Fionnuala McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, Dublin, Ireland
- National Maternity Hospital, University College Dublin, Dublin, Ireland
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10
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Davenport MH, Meah VL, Ruchat SM, Davies GA, Skow RJ, Barrowman N, Adamo KB, Poitras VJ, Gray CE, Jaramillo Garcia A, Sobierajski F, Riske L, James M, Kathol AJ, Nuspl M, Marchand AA, Nagpal TS, Slater LG, Weeks A, Barakat R, Mottola MF. Impact of prenatal exercise on neonatal and childhood outcomes: a systematic review and meta-analysis. Br J Sports Med 2018; 52:1386-1396. [DOI: 10.1136/bjsports-2018-099836] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2018] [Indexed: 12/12/2022]
Abstract
ObjectiveWe aimed to identify the relationship between maternal prenatal exercise and birth complications, and neonatal and childhood morphometric, metabolic and developmental outcomes.DesignSystematic review with random-effects meta-analysis and meta-regression.Data sourcesOnline databases were searched up to 6 January 2017.Study eligibility criteriaStudies of all designs were eligible (except case studies and reviews) if published in English, Spanish or French, and contained information on the relevant population (pregnant women without contraindication to exercise), intervention (subjective/objective measures of frequency, intensity, duration, volume or type of exercise, alone (‘exercise-only’) or in combination with other intervention components (eg, dietary; ‘exercise+cointervention’)), comparator (no exercise or different frequency, intensity, duration, volume, type or trimester of exercise) and outcomes (preterm birth, gestational age at delivery, birth weight, low birth weight (<2500 g), high birth weight (>4000 g), small for gestational age, large for gestational age, intrauterine growth restriction, neonatal hypoglycaemia, metabolic acidosis (cord blood pH, base excess), hyperbilirubinaemia, Apgar scores, neonatal intensive care unit admittance, shoulder dystocia, brachial plexus injury, neonatal body composition (per cent body fat, body weight, body mass index (BMI), ponderal index), childhood obesity (per cent body fat, body weight, BMI) and developmental milestones (including cognitive, psychosocial, motor skills)).ResultsA total of 135 studies (n=166 094) were included. There was ‘high’ quality evidence from exercise-only randomised controlled trials (RCTs) showing a 39% reduction in the odds of having a baby >4000 g (macrosomia: 15 RCTs, n=3670; OR 0.61, 95% CI 0.41 to 0.92) in women who exercised compared with women who did not exercise, without affecting the odds of growth-restricted, preterm or low birth weight babies. Prenatal exercise was not associated with the other neonatal or infant outcomes that were examined.ConclusionsPrenatal exercise is safe and beneficial for the fetus. Maternal exercise was associated with reduced odds of macrosomia (abnormally large babies) and was not associated with neonatal complications or adverse childhood outcomes.
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11
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Davenport MH, Ruchat SM, Poitras VJ, Jaramillo Garcia A, Gray CE, Barrowman N, Skow RJ, Meah VL, Riske L, Sobierajski F, James M, Kathol AJ, Nuspl M, Marchand AA, Nagpal TS, Slater LG, Weeks A, Adamo KB, Davies GA, Barakat R, Mottola MF. Prenatal exercise for the prevention of gestational diabetes mellitus and hypertensive disorders of pregnancy: a systematic review and meta-analysis. Br J Sports Med 2018; 52:1367-1375. [DOI: 10.1136/bjsports-2018-099355] [Citation(s) in RCA: 328] [Impact Index Per Article: 46.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2018] [Indexed: 12/11/2022]
Abstract
ObjectiveGestational diabetes mellitus (GDM), gestational hypertension (GH) and pre-eclampsia (PE) are associated with short and long-term health issues for mother and child; prevention of these complications is critically important. This study aimed to perform a systematic review and meta-analysis of the relationships between prenatal exercise and GDM, GH and PE.DesignSystematic review with random effects meta-analysis and meta-regression.Data sourcesOnline databases were searched up to 6 January 2017.Study eligibility criteriaStudies of all designs were included (except case studies) if published in English, Spanish or French, and contained information on the Population (pregnant women without contraindication to exercise), Intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise, alone [“exercise-only”] or in combination with other intervention components [e.g., dietary; “exercise + co-intervention”]), Comparator (no exercise or different frequency, intensity, duration, volume and type of exercise) and Outcomes (GDM, GH, PE).ResultsA total of 106 studies (n=273 182) were included. ‘Moderate’ to ‘high’-quality evidence from randomised controlled trials revealed that exercise-only interventions, but not exercise+cointerventions, reduced odds of GDM (n=6934; OR 0.62, 95% CI 0.52 to 0.75), GH (n=5316; OR 0.61, 95% CI 0.43 to 0.85) and PE (n=3322; OR 0.59, 95% CI 0.37 to 0.9) compared with no exercise. To achieve at least a 25% reduction in the odds of developing GDM, PE and GH, pregnant women need to accumulate at least 600 MET-min/week of moderate-intensity exercise (eg, 140 min of brisk walking, water aerobics, stationary cycling or resistance training).Summary/conclusionsIn conclusion, exercise-only interventions were effective at lowering the odds of developing GDM, GH and PE.
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12
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Chiavaroli V, Hopkins SA, Derraik JGB, Biggs JB, Rodrigues RO, Brennan CH, Seneviratne SN, Higgins C, Baldi JC, McCowan LME, Cutfield WS, Hofman PL. Exercise in pregnancy: 1-year and 7-year follow-ups of mothers and offspring after a randomized controlled trial. Sci Rep 2018; 8:12915. [PMID: 30150651 PMCID: PMC6110723 DOI: 10.1038/s41598-018-30925-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 07/20/2018] [Indexed: 01/21/2023] Open
Abstract
There are limited data on long-term outcomes of mothers or their offspring following exercise interventions during pregnancy. We assessed long-term effects of an exercise intervention (home-based stationary cycling) between 20–36 weeks of gestation on anthropometry and body composition in mothers and offspring after 1 and 7 years. 84 women were randomised to intervention or usual activity, with follow-up data available for 61 mother-child pairs (38 exercisers) at 1 year and 57 (33 exercisers) at 7 years. At 1 year, there were no observed differences in measured outcomes between mothers and offspring in the two groups. At the 7-year follow-up, mothers were mostly similar, except that exercisers had lower systolic blood pressure (−6.2 mmHg; p = 0.049). However, offspring of mothers who exercised during pregnancy had increased total body fat (+3.2%; p = 0.034) and greater abdominal (+4.1% android fat; p = 0.040) and gynoid (+3.5% gynoid fat; p = 0.042) adiposity compared with controls. Exercise interventions beginning during pregnancy may be beneficial to long-term maternal health. However, the initiation of exercise during pregnancy amongst sedentary mothers may be associated with adverse effects in the offspring during childhood. Larger follow-up studies are required to investigate long-term effects of exercise in pregnancy.
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Affiliation(s)
| | - Sarah A Hopkins
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - José G B Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand.,A Better Start - National Science Challenge, University of Auckland, Auckland, New Zealand.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Janene B Biggs
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | | | - Sumudu N Seneviratne
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Chelsea Higgins
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - James C Baldi
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Lesley M E McCowan
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Wayne S Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand.,A Better Start - National Science Challenge, University of Auckland, Auckland, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand.
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13
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Guillemette L, Hay JL, Kehler DS, Hamm NC, Oldfield C, McGavock JM, Duhamel TA. Exercise in Pregnancy and Children's Cardiometabolic Risk Factors: a Systematic Review and Meta-Analysis. SPORTS MEDICINE - OPEN 2018; 4:35. [PMID: 30069801 PMCID: PMC6070449 DOI: 10.1186/s40798-018-0148-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 07/03/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Maternal metabolic health during the prenatal period is an established determinant of cardiometabolic disease risk. Many studies have focused on poor offspring outcomes after exposure to poor maternal health, while few have systematically appraised the evidence surrounding the role of maternal exercise in decreasing this risk. The aim of this study is to characterize and quantify the specific impact of prenatal exercise on children's cardiometabolic health markers, at birth and in childhood. METHODS A systematic review of Scopus, MEDLINE, EMBASE, CENTRAL, CINAHL, and SPORTDiscus up to December 2017 was conducted. Randomized controlled trials (RCTs) and prospective cohort studies of prenatal aerobic exercise and/or resistance training reporting eligible offspring outcomes were included. Four reviewers independently identified eligible citations and extracted study-level data. The primary outcome was birth weight; secondary outcomes, specified a priori, included large-for-gestational age status, fat and lean mass, dyslipidemia, dysglycemia, and blood pressure. We included 73 of the 9804 citations initially identified. Data from RCTs was pooled using random effects models. Statistical heterogeneity was quantified using the I2 test. Analyses were done between June and December 2017 and the search was updated in December 2017. RESULTS Fifteen observational studies (n = 290,951 children) and 39 RCTs (n = 6875 children) were included. Observational studies were highly heterogeneous and had discrepant conclusions, but globally showed no clinically relevant effect of exercise on offspring outcomes. Meta-analyzed RCTs indicated that prenatal exercise did not significantly impact birth weight (mean difference [MD] - 22.1 g, 95% confidence interval [CI] - 51.5 to 7.3 g, n = 6766) or large-for-gestational age status (risk ratio 0.85, 95% CI 0.51 to 1.44, n = 937) compared to no exercise. Sub-group analyses showed that prenatal exercise reduced birth weight according to timing (starting after 20 weeks of gestation, MD - 84.3 g, 95% CI - 142.2, - 26.4 g, n = 1124), type of exercise (aerobic only, MD - 58.7 g, 95% CI - 109.7, - 7.8 g; n = 2058), pre-pregnancy activity status (previously inactive, MD - 34.8 g, 95% CI - 69.0, - 0.5 g; n = 2829), and exercise intensity (light to moderate intensity only, MD - 45.5 g, 95% CI - 82.4, - 8.6 g; n = 2651). Fat mass percentage at birth was not altered by prenatal exercise (0.19%, 95% CI - 0.27, 0.65%; n = 130); however, only two studies reported this outcome. Other outcomes were too scarcely reported to be meta-analyzed. CONCLUSIONS Prenatal exercise does not causally impact birth weight, fat mass, or large-for-gestational-age status in a clinically relevant way. Longer follow up of offspring exposed to prenatal exercise is needed along with measures of relevant metabolic variables (e.g., fat and lean mass). PROTOCOL REGISTRATION Protocol registration number: CRD42015029163 .
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Affiliation(s)
- Laetitia Guillemette
- Children’s Hospital Research Institute of Manitoba, John Buhler Research Center, University of Manitoba, 511-715 McDermot Avenue, Winnipeg, MB R3E 3P4 Canada
- Health, Leisure & Human Performance Research Institute, Faculty of Kinesiology & Recreation Management, University of Manitoba, Winnipeg, MB Canada
| | - Jacqueline L. Hay
- Health, Leisure & Human Performance Research Institute, Faculty of Kinesiology & Recreation Management, University of Manitoba, Winnipeg, MB Canada
- Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre, Winnipeg, MB Canada
| | - D. Scott Kehler
- Health, Leisure & Human Performance Research Institute, Faculty of Kinesiology & Recreation Management, University of Manitoba, Winnipeg, MB Canada
- Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre, Winnipeg, MB Canada
| | - Naomi C. Hamm
- Health, Leisure & Human Performance Research Institute, Faculty of Kinesiology & Recreation Management, University of Manitoba, Winnipeg, MB Canada
- Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre, Winnipeg, MB Canada
| | - Christopher Oldfield
- Health, Leisure & Human Performance Research Institute, Faculty of Kinesiology & Recreation Management, University of Manitoba, Winnipeg, MB Canada
| | - Jonathan M. McGavock
- Children’s Hospital Research Institute of Manitoba, John Buhler Research Center, University of Manitoba, 511-715 McDermot Avenue, Winnipeg, MB R3E 3P4 Canada
| | - Todd A. Duhamel
- Children’s Hospital Research Institute of Manitoba, John Buhler Research Center, University of Manitoba, 511-715 McDermot Avenue, Winnipeg, MB R3E 3P4 Canada
- Health, Leisure & Human Performance Research Institute, Faculty of Kinesiology & Recreation Management, University of Manitoba, Winnipeg, MB Canada
- Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre, Winnipeg, MB Canada
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14
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Norris T, McCarthy FP, Khashan AS, Murray DM, Kiely M, Hourihane JO, Baker PN, Kenny LC. Do changing levels of maternal exercise during pregnancy affect neonatal adiposity? Secondary analysis of the babies after SCOPE: evaluating the longitudinal impact using neurological and nutritional endpoints (BASELINE) birth cohort (Cork, Ireland). BMJ Open 2017; 7:e017987. [PMID: 29196482 PMCID: PMC5719326 DOI: 10.1136/bmjopen-2017-017987] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To investigate whether changing levels of exercise during pregnancy are related to altered neonatal adiposity. DESIGN Secondary analysis of data from a prospective cohort study. SETTING Cork, Ireland. PARTICIPANTS 1200 mother - infant pairs recruited as part of a prospective birth cohort, Babies After SCOPE: Evaluating the Longitudinal Impact Using Neurological and Nutritional Endpoints (BASELINE). MAIN OUTCOME MEASURES Neonatal adiposity was assessed within several days of birth using air displacement plethysmography (PEAPOD). Per cent body fat (BF%) as a continuous outcome and a pair of dichotomous variables; high or low adiposity, representing BF% >90th or <10th centile, respectively. Multivariable linear and logistic regression models were used to investigate the relationship between exercise and the respective outcomes. RESULTS Crude analysis revealed no association between a changing level of exercise (since becoming pregnant) at 15 weeks' gestation and any of the outcomes (BF%, low adiposity and high adiposity). At 20 weeks' gestation, analyses revealed that relative to women who do not change their exercise level up to 20 weeks, those women who decreased their exercise level were more likely to give birth to a neonate with adiposity above the 90th centile (OR 1.62, 95% CI 1.07 to 2.46). This association was maintained after adjustment for putative confounders (OR 1.62, 95% CI 1.06 to 2.47). CONCLUSIONS We observed a possible critical period for the association between changing exercise levels and neonatal adiposity, with no association observed with exercise recall for the first 15 weeks of gestation, but an association with a decreasing level of exercise between 15 and 20 weeks. These results should be interpreted in line with the limitations of the study and further studies utilising objectively measured estimates of exercise are required in order to replicate these findings. TRIAL REGISTRATION NUMBER NCT01498965.
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Affiliation(s)
- Tom Norris
- Department of Health Sciences, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK
| | - Fergus P McCarthy
- Department of Obstetrics and Gynecology, The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork, Ireland
- Division of Women's Health KCL, Women's Health Academic Centre KHP, St Thomas's Hospital, London, UK
| | - Ali S Khashan
- Department of Obstetrics and Gynecology, The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork, Ireland
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Deidre M Murray
- Department of Obstetrics and Gynecology, The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Mairead Kiely
- Department of Obstetrics and Gynecology, The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork, Ireland
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Jonathan O'B Hourihane
- Department of Obstetrics and Gynecology, The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Philip N Baker
- College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Louise C Kenny
- Department of Obstetrics and Gynecology, The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork, Ireland
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16
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Moyer C, Reoyo OR, May L. The Influence of Prenatal Exercise on Offspring Health: A Review. CLINICAL MEDICINE INSIGHTS. WOMEN'S HEALTH 2016; 9:37-42. [PMID: 27777506 PMCID: PMC5075987 DOI: 10.4137/cmwh.s34670] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 09/05/2016] [Accepted: 09/07/2016] [Indexed: 12/11/2022]
Abstract
Research has continued to demonstrate that exercise during pregnancy is safe. Growing evidence supports that exercise during pregnancy is beneficial for mother and fetus during gestation, with benefits persisting for the child into adulthood. Regardless of income or socioeconomic status, exercise during pregnancy is associated with increased incidence of full-term delivery. Additionally, normalization of birth measures, such as birth weight, occurs when women perform regular exercise throughout gestation. Measures of growth and development further indicate that exercise during pregnancy does not harm and may stimulate healthy growth throughout childhood. Measures of cognition and intelligence demonstrate that exercise during pregnancy causes no harm and may be beneficial. Overall, the benefits of exercise during pregnancy decrease the risk of chronic disease for both mother and child.
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Affiliation(s)
- Carmen Moyer
- Visiting Assistant Professor, Health and Human Sciences, Bridgewater College, Bridgewater, VA, USA
| | | | - Linda May
- Assistant Professor, Foundational Sciences and Research, East Carolina University, Greenville, NC, USA
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17
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Kiely ME, Zhang JY, Kinsella M, Khashan AS, Kenny LC. Vitamin D status is associated with uteroplacental dysfunction indicated by pre-eclampsia and small-for-gestational-age birth in a large prospective pregnancy cohort in Ireland with low vitamin D status. Am J Clin Nutr 2016; 104:354-61. [PMID: 27357092 DOI: 10.3945/ajcn.116.130419] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 05/25/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Associations between vitamin D and pregnancy outcomes have been inconsistent. OBJECTIVES We described the distribution of 25-hydroxyvitamin D3 [25(OH)D3], 3-epi-25(OH)D3, and 25(OH)D2 in early pregnancy and investigated associations with pre-eclampsia and small-for-gestational-age (SGA) birth, which are indicative of uteroplacental dysfunction. DESIGN The SCOPE (Screening for Pregnancy Endpoints) Ireland prospective pregnancy cohort study included 1768 well-characterized low-risk, nulliparous women resident at 52°N. Serum 25(OH)D3, 3-epi-25(OH)D3, and 25(OH)D2 were quantified at 15 wk of gestation with the use of a CDC-accredited liquid chromatography-tandem mass spectrometry method. RESULTS The mean ± SD total 25(OH)D concentration was 56.7 ± 25.9 nmol/L, and 17% and 44% of women had 25(OH)D concentrations <30 and <50 nmol/L, respectively. The prevalence of pre-eclampsia was 3.8%, and 10.7% of infants were SGA. There was a lower risk of pre-eclampsia plus SGA combined (13.6%) at 25(OH)D concentrations >75 nmol/L (adjusted OR: 0.64; 95% CI: 0.43, 0.96). The main predictors of 25(OH)D were the use of vitamin D-containing supplements (adjusted mean difference: 20.1 nmol/L; 95% CI: 18.5, 22.7 nmol/L) and summer sampling (adjusted mean difference: 15.5 nmol/L; 95% CI: 13.4, 17.6 nmol/L). Non-Caucasian ethnicity (adjusted mean difference: -19.3 nmol/L; 95% CI: -25.4, -13.2 nmol/L) and smoking (adjusted mean difference: -7.0 nmol/L; 95% CI: -10.5, -3.6 nmol/L) were negative predictors of 25(OH)D. The mean ± SD concentration of 3-epi-25(OH)D3, which was detectable in 99.9% of samples, was 2.6 ± 1.6 nmol/L. Determinants of 3-epi-25(OH)D3 were 25(OH)D3 (adjusted mean difference: 0.052 nmol/L; 95% CI: 0.050, 0.053 nmol/L) and maternal age (adjusted mean difference: -0.018 nmol/L; 95% CI: -0.026, -0.009 nmol/L). The mean ± SD concentration of 25(OH)D2 was 3.1 ± 2.7 nmol/L, which was present in all samples. No adverse effects of 25(OH)D concentrations >125 nmol/L were observed. CONCLUSIONS In the first report to our knowledge of CDC-accredited 25(OH)D data and pregnancy outcomes from a large, clinically validated, prospective cohort study, we observed a protective association of a 25(OH)D concentration >75 nmol/L and a reduced risk of uteroplacental dysfunction as indicated by a composite outcome of SGA and pre-eclampsia. Well-designed, adequately powered randomized controlled trials are required to verify this observation. The SCOPE pregnancy cohort was registered at www.anzctr.org.au as ACTRN12607000551493.
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Affiliation(s)
- Mairead E Kiely
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, The Irish Centre for Fetal and Neonatal Translational Research, and
| | - Joy Y Zhang
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences
| | - Michael Kinsella
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences
| | - Ali S Khashan
- The Irish Centre for Fetal and Neonatal Translational Research, and Departments of Epidemiology and Public Health and
| | - Louise C Kenny
- The Irish Centre for Fetal and Neonatal Translational Research, and Obstetrics and Gynecology, University College Cork, Cork, Ireland
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18
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Bisson M, Lavoie-Guénette J, Tremblay A, Marc I. Physical Activity Volumes during Pregnancy: A Systematic Review and Meta-Analysis of Observational Studies Assessing the Association with Infant's Birth Weight. AJP Rep 2016; 6:e170-97. [PMID: 27127718 PMCID: PMC4848034 DOI: 10.1055/s-0036-1583169] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 03/03/2016] [Indexed: 12/16/2022] Open
Abstract
Objective This study aims to examine the association between different maternal physical activity exposures during pregnancy and infant's birth weight, body composition, and risk of inadequate weight. Methods Two reviewers (M.B. and J.L.G.) identified observational studies reporting total or leisure time activity during pregnancy and birth weight outcomes. Pooled analyses were performed to summarize the risk associated with high or moderate volumes of physical activity on birth weight. Results A total of 54 studies among 4,080 reported the association between physical activity and birth weight (37 studies) or risks of small or large birth weight. The association between physical activity and birth weight was evaluated by physical activity levels (low, moderate, or high). Despite heterogeneity, pooled results (23 studies) suggested that moderate levels of activity are associated with an increased birth weight (mean difference: 61.5 g, 95% confidence interval [CI]: 16.6, 106.5, 15 studies), while high levels were associated with lower birth weight (mean difference: -69.9 g, 95% CI: -114.8, -25.0, 15 studies). Data were insufficient to provide robust estimates for other outcomes. Conclusions The results of observational studies suggest an inverted u-shaped association between physical activity and birth weight, despite methodological variability. These results could help refining physical activity guidelines for pregnancy and provide guidance for future research.
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Affiliation(s)
- Michèle Bisson
- Department of Pediatrics, Centre Hospitalier Universitaire de Québec (CHU de Québec), Université Laval, Quebec, Canada
- Department of Kinesiology, Faculty of Medicine, Université Laval, Quebec, Canada
| | - Joëlle Lavoie-Guénette
- Department of Pediatrics, Centre Hospitalier Universitaire de Québec (CHU de Québec), Université Laval, Quebec, Canada
| | - Angelo Tremblay
- Department of Kinesiology, Faculty of Medicine, Université Laval, Quebec, Canada
| | - Isabelle Marc
- Department of Pediatrics, Centre Hospitalier Universitaire de Québec (CHU de Québec), Université Laval, Quebec, Canada
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Tinius RA, Cahill AG, Cade WT. Impact of physical activity during pregnancy on obstetric outcomes in obese women. J Sports Med Phys Fitness 2015; 57:652-659. [PMID: 26564274 DOI: 10.23736/s0022-4707.17.06222-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Maternal obesity is associated with complications and adverse outcomes during the labor and delivery process. In pregnant women with a healthy body weight, maternal physical activity during pregnancy is associated with better obstetric outcomes; however, the effect of maternal physical activity during pregnancy on obstetric outcomes in obese women is not known. The purpose of the study was to determine the influence of self-reported physical activity levels on obstetric outcomes in pregnant obese women. METHODS A retrospective chart review was performed on 48 active obese women and 48 inactive obese women (N.=96) who received prenatal care and delivered at the medical center during the past five years. Obstetric and neonatal outcomes were compared between the active and inactive groups. RESULTS Obese women who were active during pregnancy spent less total time in labor (13.4 hours vs. 19.2 hours, P=0.048) and were less likely to request an epidural (92% vs. 100%, P=0.04). When stratified by parity, active multiparous women spent significantly less total time in labor compared to inactive multiparous (6.2 hours vs. 16.7 hours, P=0.018). There were no statistical differences between groups in rates of cesarean deliveries or neonatal outcomes. CONCLUSIONS Maternal physical activity during pregnancy appears to improve obstetric outcomes in obese women, and this improvement may be more pronounced among multiparous women. Our finding is of particular importance as pregnant obese women are at higher risk for adverse labor and delivery outcomes.
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Affiliation(s)
- Rachel A Tinius
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA - .,School of Kinesiology, Recreation, and Sport, Western Kentucky University, Bowling Green, KY, USA -
| | - Alison G Cahill
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - W Todd Cade
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
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21
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Raipuria M, Bahari H, Morris MJ. Effects of maternal diet and exercise during pregnancy on glucose metabolism in skeletal muscle and fat of weanling rats. PLoS One 2015; 10:e0120980. [PMID: 25853572 PMCID: PMC4390148 DOI: 10.1371/journal.pone.0120980] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 02/09/2015] [Indexed: 11/19/2022] Open
Abstract
Obesity during pregnancy contributes to the development of metabolic disorders in offspring. Maternal exercise may limit gestational weight gain and ameliorate these programming effects. We previously showed benefits of post-weaning voluntary exercise in offspring from obese dams. Here we examined whether voluntary exercise during pregnancy influences lipid and glucose homeostasis in muscle and fat in offspring of both lean and obese dams. Female Sprague-Dawley rats were fed chow (C) or high fat (F) diet for 6 weeks before mating. Half underwent voluntary exercise (CE/FE) with a running wheel introduced 10 days prior to mating and available until the dams delivered; others remained sedentary (CS/FS). Male and female pups were killed at postnatal day (PND)19 and retroperitoneal fat and gastrocnemius muscle were collected for gene expression. Lean and obese dams achieved similar modest levels of exercise. At PND1, both male and female pups from exercised lean dams were significantly lighter (CE versus CS), with no effect in those from obese dams. At PND19, maternal obesity significantly increased offspring body weight and adiposity, with no effect of maternal exercise. Exercise significantly reduced insulin concentrations in males (CE/FE versus CS/FS), with reduced glucose in male FE pups. In males, maternal obesity significantly decreased muscle myogenic differentiation 1 (MYOD1) and glucose transporter type 4 (GLUT4) mRNA expressions (FS vs CS); these were normalized by exercise. Maternal exercise upregulated adipose GLUT4, interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and peroxisome proliferator activated receptor gamma coactivator 1 alpha (PGC1α) mRNA expression in offspring of dams consuming chow. Modest voluntary exercise during pregnancy was associated with lower birth weight in pups from lean dams. Maternal exercise appeared to decrease the metabolic risk induced by maternal obesity, improving insulin/glucose metabolism, with greater effects in male than female offspring.
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Affiliation(s)
- Mukesh Raipuria
- Department of Pharmacology, School of Medical Sciences, UNSW Australia, Sydney, NSW 2052, Australia
| | - Hasnah Bahari
- Department of Pharmacology, School of Medical Sciences, UNSW Australia, Sydney, NSW 2052, Australia
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Margaret J. Morris
- Department of Pharmacology, School of Medical Sciences, UNSW Australia, Sydney, NSW 2052, Australia
- * E-mail:
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Seneviratne SN, McCowan LME, Cutfield WS, Derraik JGB, Hofman PL. Exercise in pregnancies complicated by obesity: achieving benefits and overcoming barriers. Am J Obstet Gynecol 2015; 212:442-9. [PMID: 24909342 DOI: 10.1016/j.ajog.2014.06.009] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 05/08/2014] [Accepted: 06/03/2014] [Indexed: 01/21/2023]
Abstract
An increasing number of women are entering pregnancy in an overweight or obese state. Obese women and their offspring are at increased risk of adverse perinatal outcomes, which may be improved by regular moderate-intensity antenatal exercise. Current guidelines recommend that all pregnant women without contraindications engage in ≥30 minutes of moderate-intensity exercise on a daily basis. However, obese women are usually less physically active and tend to further reduce activity levels during pregnancy. This commentary summarizes the potential short- and long-term benefits of antenatal exercise in obese pregnant women, highlights the challenges they face, and discusses means of improving their exercise levels. In addition, we make recommendations on exercise prescription for pregnancies complicated by obesity.
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Affiliation(s)
- Sumudu N Seneviratne
- Liggins Institute, University of Auckland, Auckland, New Zealand; Gravida: National Centre for Growth and Development, University of Auckland, Auckland, New Zealand
| | - Lesley M E McCowan
- Gravida: National Centre for Growth and Development, University of Auckland, Auckland, New Zealand; Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
| | - Wayne S Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand; Gravida: National Centre for Growth and Development, University of Auckland, Auckland, New Zealand
| | - José G B Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand; Gravida: National Centre for Growth and Development, University of Auckland, Auckland, New Zealand.
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Hellenes OM, Vik T, Løhaugen GC, Salvesen KÅ, Stafne SN, Mørkved S, Evensen KAI. Regular moderate exercise during pregnancy does not have an adverse effect on the neurodevelopment of the child. Acta Paediatr 2015; 104:285-91. [PMID: 25471255 DOI: 10.1111/apa.12890] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 02/10/2014] [Accepted: 01/12/2014] [Indexed: 12/16/2022]
Abstract
AIM Current U.S. guidelines suggest that pregnant women should exercise regularly during pregnancy, and we examined the neurodevelopment of the children whose mothers had taken that advice. METHODS This Norwegian study included 188 children whose mothers had followed a structured exercise protocol and 148 control children whose mothers had not. Their cognitive, language and motor skills were assessed at 18 months of age by the Bayley Scales of Infant Development-III and daily life functioning with the Ages and Stages Questionnaire. RESULTS No significant differences were found between the two groups. Subgroup analyses revealed that the children whose mothers had exercised had a slightly lower motor composite score (mean: 97.6, 95% CI: 96.0-99.2) than the control group (mean: 100.0, 95% CI: 98.6-101.5) (p = 0.03). Boys in the intervention group had lower fine motor scores (mean: 10.6, 95% CI: 10.3-11.0) than boys in the control group (mean: 11.5, 95% CI: 11.0-11.9) (p = 0.01). CONCLUSION Our main finding was that regular moderate exercise during pregnancy does not adversely affect neurodevelopment in children. The lower motor scores in the subgroup analyses are probably clinically insignificant, but the lower fine motor scores for boys in the intervention group warrant further research.
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Affiliation(s)
| | - Torstein Vik
- Department of Laboratory Medicine; Children and Women's Health; Norwegian University of Science and Technology; Trondheim Norway
| | - Gro C. Løhaugen
- Department of Laboratory Medicine; Children and Women's Health; Norwegian University of Science and Technology; Trondheim Norway
- Department of Paediatrics; Sørlandet Hospital; Arendal Norway
| | - Kjell Åsmund Salvesen
- Department of Laboratory Medicine; Children and Women's Health; Norwegian University of Science and Technology; Trondheim Norway
- Clinical Sciences; Obstetrics and Gynaecology; Lund University; Lund Sweden
| | - Signe N. Stafne
- Department of Public Health and General Practice; Norwegian University of Science and Technology; Trondheim Norway
- Clinical Services; St. Olavs Hospital; Trondheim Norway
| | - Siv Mørkved
- Department of Public Health and General Practice; Norwegian University of Science and Technology; Trondheim Norway
- Clinical Services; St. Olavs Hospital; Trondheim Norway
| | - Kari Anne I. Evensen
- Department of Public Health and General Practice; Norwegian University of Science and Technology; Trondheim Norway
- Department of Physiotherapy; Trondheim Municipality; Trondheim Norway
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Physical activity, sedentary behaviour and fetal macrosomia in uncomplicated pregnancies: a prospective cohort study. Midwifery 2014; 30:1202-9. [PMID: 24861673 DOI: 10.1016/j.midw.2014.04.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 04/04/2014] [Accepted: 04/25/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE to explore maternal energy balance, incorporating free living physical activity and sedentary behaviour, in uncomplicated pregnancies at risk of macrosomia. METHODS a parallel-group cross-sectional analysis was conducted in healthy pregnant women predicted to deliver infants weighing ≥ 4000 g (study group) or < 4000 g (control group). Women were recruited in a 1:1 ratio from antenatal clinics in Northern Ireland. Women wore a SenseWear(®) Body Media Pro3 physical activity armband and completed a food diary for four consecutive days in the third trimester. Physical activity was measured in Metabolic Equivalent of Tasks (METs) where 1 MET = 1 kcal per kilogram of body weight per hour. Analysis of covariance (ANCOVA) was employed using the General Linear Model to adjust for potential confounders. FINDINGS of the 112 women recruited, 100 complete datasets were available for analysis. There was no significant difference in energy balance between the two groups. Intensity of free living physical activity (average METs) of women predicted to deliver macrosomic infants (n = 50) was significantly lower than that of women in the control group (n = 50) (1.3 (0.2) METs (mean, standard deviation) versus 1.2 (0.2) METs; difference in means -0.1 METs (95% confidence interval: -0.19, -0.01); p = 0.021). Women predicted to deliver macrosomic infants also spent significantly more time in sedentary behaviour (≤ 1 MET) than the control group (16.1 (2.8) hours versus 13.8 (4.3) hours; 2.0 hours (0.3, 3.7), p = 0.020). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE although there was no association between predicted fetal macrosomia and energy balance, those women predicted to deliver a macrosomic infant exhibited increased sedentary behaviour and reduced physical activity in the third trimester of pregnancy. Professionals caring for women during pregnancy have an important role in promoting and supporting more active lifestyles amongst women who are predicted to deliver a macrosomic infant given the known associated risks.
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McCowan LME, Thompson JMD, Taylor RS, North RA, Poston L, Baker PN, Myers J, Roberts CT, Dekker GA, Simpson NAB, Walker JJ, Kenny LC. Clinical prediction in early pregnancy of infants small for gestational age by customised birthweight centiles: findings from a healthy nulliparous cohort. PLoS One 2013; 8:e70917. [PMID: 23940665 PMCID: PMC3733741 DOI: 10.1371/journal.pone.0070917] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 06/24/2013] [Indexed: 12/25/2022] Open
Abstract
Objective Small for gestational age (SGA) infants comprise up to 50% of all stillbirths and a minority are detected before birth. We aimed to develop and validate early pregnancy predictive models for SGA infants. Methods 5628 participants from SCOPE, a prospective study of nulliparous pregnant women, were interviewed at 15±1 weeks’ gestation. Fetal anthropometry, uterine and umbilical Doppler studies were performed at 20±1 weeks’. The cohort was divided into training (n = 3735) and validation datasets (n = 1871). All-SGA (birthweight <10th customised centile), Normotensive-SGA (SGA with normotensive mother) and Hypertensive-SGA (SGA with mother who developed hypertension) were the primary outcomes. Multivariable analysis was performed using stepwise logistic regression firstly using clinical variables and then with clinical and ultrasound variables. Receiver operator curves were constructed and areas under the curve (AUC) calculated. Results 633 infants (11.3%) in the whole cohort were SGA; 465 (8.3%) Normotensive-SGA and 165 (3.0%) Hypertensive-SGA. In the training dataset risk factors for All-SGA at 15±1 weeks’ included: family history of coronary heart disease, maternal birthweight <3000 g and 3000 g to 3499 g compared with ≥3500 g, >12 months to conceive, university student, cigarette smoking, proteinuria, daily vigorous exercise and diastolic blood pressure ≥80. Recreational walking ≥4 times weekly, rhesus negative blood group and increasing random glucose were protective. AUC for clinical risk factors was 0.63. Fetal abdominal or head circumference z scores <10th centile and increasing uterine artery Doppler resistance at 20±1 weeks’ were associated with increased risk. Addition of these parameters increased the AUC to 0.69. Clinical predictors of Normotensive and Hypertensive-SGA were sub-groups of All-SGA predictors and were quite different. The combined clinical and ultrasound AUC for Normotensive and Hypertensive-SGA were 0.69 and 0.82 respectively. Conclusion Predictors for SGA of relevance to clinical practice were identified. The identity and predictive potential differed in normotensive women and those who developed hypertension.
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Affiliation(s)
- Lesley M E McCowan
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand.
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Siebel AL, Carey AL, Kingwell BA. Can exercise training rescue the adverse cardiometabolic effects of low birth weight and prematurity? Clin Exp Pharmacol Physiol 2013; 39:944-57. [PMID: 22882133 DOI: 10.1111/j.1440-1681.2012.05732.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Being born preterm and/or small for gestational age are well-established risk factors for cardiometabolic disease in adulthood. Physical activity has the potential to mitigate against the detrimental cardiometabolic effects of low birth weight from two perspectives: (i) maternal exercise prior to and during pregnancy; and (ii) exercise during childhood or adulthood for those born small or prematurely. Evidence from epidemiological birth cohort studies suggests that the effects of moderate-intensity physical activity during pregnancy on mean birth weight are small, but reduce the risk of either high or low birth weight infants. In contrast, vigorous and/or high-intensity exercise during pregnancy has been associated with reduced birth weight. In childhood and adolescence, exercise ability is compromised in extremely low birth weight individuals (< 1000 g), but only marginally reduced in those of very low to low birth weight (1000-2500 g). Epidemiological studies show that the association between birth weight and metabolic disease is lost in physically fit individuals and, consistently, that the association between low birth weight and metabolic syndrome is accentuated in unfit individuals. Physical activity intervention studies indicate that most cardiometabolic risk factors respond to exercise in a protective manner, independent of birth weight. The mechanisms by which exercise may protect low birth weight individuals include restoration of muscle mass, reduced adiposity and enhanced β-cell mass and function, as well as effects on both aerobic and anaerobic muscle metabolism, including substrate utilization and mitochondrial function. Vascular and cardiac adaptations are also likely important, but are less well studied.
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Affiliation(s)
- Andrew L Siebel
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
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27
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Lain KY, Catalano PM. Factors that affect maternal insulin resistance and modify fetal growth and body composition. Metab Syndr Relat Disord 2012; 4:91-100. [PMID: 18370755 DOI: 10.1089/met.2006.4.91] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Fetal growth is multifactorial and can be altered by a variety of extrinsic and intrinsic factors. The maternal, placental, and fetal contribution to growth must all be considered. Of particular interest are maternal metabolic regulation and the availability of nutrients to the developing fetus. Weight gain, hyperlipidemia, and insulin resistance occur as a normal adaptation to pregnancy. Obesity and underlying insulin resistance among women of reproductive age are rapidly increasing, and the contribution of pregnancy on this abnormal metabolic background poses additional maternal and fetal challenges. Many components of the metabolic syndrome have been associated with changes in fetal growth, including obesity, dyslipidemia, hypertension, and insulin resistance or glucose intolerance. Additional factors affect fetal growth and include diet, exercise, and smoking. In this review, we briefly discuss the importance and descriptions of fetal growth, followed by a discussion of several of the extrinsic and intrinsic established factors affecting fetal growth. We highlight factors that may modify fetal growth and body composition directly or indirectly through alterations in maternal metabolism.
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Affiliation(s)
- Kristine Y Lain
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Kentucky; Lexington, Kentucky
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28
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The potential impact of physical activity during pregnancy on maternal and neonatal outcomes. Obstet Gynecol Surv 2012; 67:99-110. [PMID: 22325300 DOI: 10.1097/ogx.0b013e318242030e] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Pregnancy is a critical period of body weight regulation. Maternal obesity and excessive gestational weight gain have become increasingly common and contribute to poor obstetrical outcomes for mother and baby. Regular participation in physical activity may improve risk profiles in pregnant women. PURPOSE AND METHODS Our objectives were to provide an overview of maternal-fetal exercise physiology, summarize current evidence on the effects of physical activity during pregnancy on maternal-fetal outcomes, and review the most recent clinical practice guidelines. In addition, we summarize the findings in the context of the current obesity epidemic and discuss implications for clinical practice. A literature review was completed in which we queried OVID (Medline), EMBASE, and PSYCHINFO databases with title words "exercise or physical activity" and "pregnancy or gestation" from 1950 to March 1, 2010. A total of 212 articles were selected for review. RECOMMENDATIONS Care providers should recommend physical activity to most pregnant women (i.e., those without contraindications) and view participation as a safe and beneficial component of a healthy pregnancy. TARGET AUDIENCE Obstetricians & Gynecologists and Family Physicians. LEARNING OBJECTIVES After participating in this CME activity, physicians should be better able to classify the potential impact of physical activity on maternal glycemic control and fetal growth outcomes. Assess maternal lifestyle and provide recommendations on appropriate gestational weight gain, evaluate pregnant women for contraindications to physical activity participation, make individualized recommendations for exercise participation, and educate patients on the merits of physical activity for health benefit.
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Maternal Recreational Exercise during Pregnancy in relation to Children's BMI at 7 Years of Age. Int J Pediatr 2012; 2012:920583. [PMID: 22548089 PMCID: PMC3324144 DOI: 10.1155/2012/920583] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 01/20/2012] [Accepted: 01/26/2012] [Indexed: 12/16/2022] Open
Abstract
Exposures during fetal life may have long-term health consequences including risk of childhood overweight. We investigated the associations between maternal recreational exercise during early and late pregnancy and the children's body mass index (BMI) and risk of overweight at 7 years. Data on 40,280 mother-child pairs from the Danish National Birth Cohort was used. Self-reported information about exercise was obtained from telephone interviews around gestational weeks 16 and 30. Children's weight and height were reported in a 7-year follow-up and used to calculate BMI and overweight status. Data was analyzed using multiple linear and logistic regression models. Recreational exercise across pregnancy was inversely related to children's BMI and risk of overweight, but all associations were mainly explained by smoking habits, socioeconomic status, and maternal pre-pregnancy BMI. Additionally, we did not find exercise intensity or changes in exercise habits in pregnancy related to the children's BMI or risk of overweight.
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30
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Adamo KB, Ferraro ZM, Brett KE. Can we modify the intrauterine environment to halt the intergenerational cycle of obesity? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2012; 9:1263-307. [PMID: 22690193 PMCID: PMC3366611 DOI: 10.3390/ijerph9041263] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 02/24/2012] [Accepted: 02/27/2012] [Indexed: 02/07/2023]
Abstract
Child obesity is a global epidemic whose development is rooted in complex and multi-factorial interactions. Once established, obesity is difficult to reverse and epidemiological, animal model, and experimental studies have provided strong evidence implicating the intrauterine environment in downstream obesity. This review focuses on the interplay between maternal obesity, gestational weight gain and lifestyle behaviours, which may act independently or in combination, to perpetuate the intergenerational cycle of obesity. The gestational period, is a crucial time of growth, development and physiological change in mother and child. This provides a window of opportunity for intervention via maternal nutrition and/or physical activity that may induce beneficial physiological alternations in the fetus that are mediated through favourable adaptations to in utero environmental stimuli. Evidence in the emerging field of epigenetics suggests that chronic, sub-clinical perturbations during pregnancy may affect fetal phenotype and long-term human data from ongoing randomized controlled trials will further aid in establishing the science behind ones predisposition to positive energy balance.
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Affiliation(s)
- Kristi B. Adamo
- Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada; (Z.M.F.); (K.E.B.)
- Faculty of Medicine, Pediatrics, University of Ottawa, Ottawa, ON K1H 8L1, Canada
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, ON K1H 8L1, Canada
| | - Zachary M. Ferraro
- Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada; (Z.M.F.); (K.E.B.)
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, ON K1H 8L1, Canada
| | - Kendra E. Brett
- Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada; (Z.M.F.); (K.E.B.)
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, ON K1H 8L1, Canada
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Walsh JM, McAuliffe FM. Prediction and prevention of the macrosomic fetus. Eur J Obstet Gynecol Reprod Biol 2012; 162:125-30. [PMID: 22459652 DOI: 10.1016/j.ejogrb.2012.03.005] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 02/27/2012] [Accepted: 03/02/2012] [Indexed: 12/18/2022]
Abstract
Fetal macrosomia is associated with significant maternal and neonatal morbidity. In the long term, infants who are large for gestational age are more likely than other infants to be obese in childhood, adolescence and early adulthood, and are inherently at higher risk of cardiovascular and metabolic complications in adulthood. With over one billion adults in the world now overweight and more than 600 million clinically obese, preventing the vicious cycle effect of fetal macrosomia and childhood obesity is an increasingly pertinent issue. Fetal growth is determined by a complex interplay of various genetic and environmental influences. Consequently the prediction of pregnancies at risk of pathological overgrowth is difficult. Many risk factors for fetal macrosomia, such as maternal obesity and advanced maternal age, are also conversely associated with intrauterine growth restriction. Sonographic detection of fetal macrosomia is notoriously fraught with difficulties, with dozens of formulas for estimated fetal weight proposed but few with sufficient sensitivity to alter clinical practice. This calls into question policies of elective delivery based on projected estimated fetal weight cut-offs alone. More recently the identification of markers of fetal adiposity and maternal serum biomarkers are being investigated to improve the antenatal detection of the large for gestational age fetus. Prevention of fetal macrosomia is entirely dependent upon correct identification of those at risk. Maternal weight, gestational weight gain and glycaemic control are the risk factors for fetal macrosomia that are most amenable to intervention, and have potential maternal health benefits beyond pregnancy and childbirth. The ideal method of optimising maternal weight and glucose homeostasis is yet to be elucidated, though a number of promising advances are recently being reported. In this review we outline the contemporary evidence for the prediction and prevention of fetal macrosomia, which is indeed a contemporary dilemma.
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Affiliation(s)
- Jennifer M Walsh
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland.
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Walsh JM, McGowan C, Byrne J, McAuliffe FM. Prevalence of physical activity among healthy pregnant women in Ireland. Int J Gynaecol Obstet 2011; 114:154-5. [DOI: 10.1016/j.ijgo.2011.02.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 02/18/2011] [Accepted: 04/27/2011] [Indexed: 11/26/2022]
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Rosa BV, Firth EC, Blair HT, Vickers MH, Morel PCH. Voluntary exercise in pregnant rats positively influences fetal growth without initiating a maternal physiological stress response. Am J Physiol Regul Integr Comp Physiol 2011; 300:R1134-41. [DOI: 10.1152/ajpregu.00683.2010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The effects of increased physical activity during pregnancy on the health of the offspring in later life are unknown. Research in this field requires an animal model of exercise during pregnancy that is sufficiently strenuous to cause an effect but does not elicit a stress response. Previously, we demonstrated that two models of voluntary exercise in the nonpregnant rat, tower climbing and rising to an erect bipedal stance (squat), cause bone modeling without elevating the stress hormone corticosterone. In this study, these same models were applied to pregnant rats. Gravid Wistar rats were randomly divided into three groups: control, tower climbing, and squat exercise. The rats exercised throughout pregnancy and were killed at day 19. Maternal stress was assessed by fecal corticosterone measurement. Maternal bone and soft tissue responses to exercise were assessed by peripheral quantitative computed tomography and dual-energy X-ray absorptiometry. Maternal weight gain during the first 19 days of pregnancy was less in exercised than in nonexercised pregnant control rats. Fecal corticosterone levels did not differ between the three maternal groups. The fetuses responded to maternal exercise in a uterine position-dependent manner. Mid-uterine horn fetuses from the squat exercise group were heavier ( P < 0.0001) and longer ( P < 0.0001) and had a greater placental weight ( P = 0.001) than those from control rats. Fetuses from tower-climbing dams were longer ( P < 0.0001) and had heavier placentas ( P = 0.01) than those from control rats, but fetal weight did not differ from controls. These models of voluntary exercise in the rat may be useful for future studies of the effects of exercise during pregnancy on the developmental origins of health and disease.
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Affiliation(s)
- Brielle V. Rosa
- National Research Centre for Growth and Development, Institute of Veterinary, Animal, and Biomedical Sciences,
| | - Elwyn C. Firth
- National Research Centre for Growth and Development, Institute of Veterinary, Animal, and Biomedical Sciences,
| | - Hugh T. Blair
- National Research Centre for Growth and Development, Institute of Veterinary, Animal, and Biomedical Sciences,
| | - Mark H. Vickers
- National Research Centre for Growth and Development, Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Patrick C. H. Morel
- National Research Centre for Growth and Development, Institute of Food, Nutrition, and Human Health, Massey University, Palmerston North; and
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McCowan LME, Roberts CT, Dekker GA, Taylor RS, Chan EHY, Kenny LC, Baker PN, Moss-Morris R, Chappell LC, North RA. Risk factors for small-for-gestational-age infants by customised birthweight centiles: data from an international prospective cohort study. BJOG 2010; 117:1599-607. [DOI: 10.1111/j.1471-0528.2010.02737.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Nelson SM, Matthews P, Poston L. Maternal metabolism and obesity: modifiable determinants of pregnancy outcome. Hum Reprod Update 2010; 16:255-75. [PMID: 19966268 PMCID: PMC2849703 DOI: 10.1093/humupd/dmp050] [Citation(s) in RCA: 247] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Revised: 10/06/2009] [Accepted: 10/15/2009] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Obesity among pregnant women is highly prevalent worldwide and is associated in a linear manner with markedly increased risk of adverse outcome for mother and infant. Obesity in the mother may also independently confer risk of obesity to her child. The role of maternal metabolism in determining these outcomes and the potential for lifestyle modification are largely unknown. METHODS Relevant studies were identified by searching PubMed, the metaRegister of clinical trials and Google Scholar without limitations. Sensitive search strategies were combined with relevant medical subject headings and text words. RESULTS Maternal obesity and gestational weight gain have a significant impact on maternal metabolism and offspring development. Insulin resistance, glucose homeostasis, fat oxidation and amino acid synthesis are all disrupted by maternal obesity and contribute to adverse outcomes. Modification of lifestyle is an effective intervention strategy for improvement of maternal metabolism and the prevention of type 2 diabetes and, potentially, gestational diabetes. CONCLUSIONS Maternal obesity requires the development of effective interventions to improve pregnancy outcome. Strategies that incorporate a detailed understanding of the maternal metabolic environment and its consequences for the health of the mother and the growth of the child are likely to identify the best approach.
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Affiliation(s)
- Scott M Nelson
- Division of Developmental Medicine, Reproductive and Maternal Medicine, Faculty of Medicine, University of Glasgow, Glasgow, UK.
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Gollenberg AL, Pekow P, Bertone-Johnson ER, Freedson PS, Markenson G, Chasan-Taber L. Physical Activity and Risk of Small-for-Gestational-Age Birth Among Predominantly Puerto Rican Women. Matern Child Health J 2010; 15:49-59. [DOI: 10.1007/s10995-009-0563-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bang SW, Lee SS. The factors affecting pregnancy outcomes in the second trimester pregnant women. Nutr Res Pract 2009; 3:134-40. [PMID: 20016714 PMCID: PMC2788170 DOI: 10.4162/nrp.2009.3.2.134] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2009] [Revised: 05/18/2009] [Accepted: 05/25/2009] [Indexed: 12/01/2022] Open
Abstract
Adequate nutrient intake during pregnancy is important to fetal and maternal health. The purpose of this study was to investigate the factors affecting birth weight and gestational age and to provide basic data to promote more favorable pregnancy outcomes. Data were collected from 234 pregnant women at two hospitals in Seoul. Demographic characteristics, anthropometric measurements and health related habits were obtained using a questionnaire at the hospital visit during the second trimester. Dietary intakes were estimated by 24 hour recall at the hospital visit during the second trimester. Data on pregnancy outcomes, including birth weights and gestational ages, were obtained from hospital records after delivery. Birth weights were divided into a low birth weight group (birth weight<3.1 kg), a normal birth weight group (3.1-3.6 kg) and a high birth weight group (>3.6 kg). Gestational ages were divided into tertiles according to the gestational age of the subjects: group 1 (<38.53 weeks), group 2 (38.53-40.00 weeks) and group 3 (>40.00 weeks). The number of family members was significantly lower in the low birth weight group than in the normal birth weight group (p<0.05). In the low birth weight group, pregnancy weight was significantly lower than in the high birth weight group (p<0.05). Health related habits were not significantly different among any of the groups. Intakes of fiber, phosphorous, iron, vitamin B6 and folic acid were significantly higher in the high birth weight group than the low birth weight group (p<0.05). Gestational age was not significantly affected by nutrient intakes, but birth weight was affected by nutrient intake in the results of this study. Therefore, the adequacy of nutrient intake is important for the improvement of pregnancy outcomes.
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Affiliation(s)
- Seo Won Bang
- Department of Food & Nutrition, Hanyang University, Haengdang-dong, Seongdong-gu, Seoul 133-791, Korea
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Hegaard HK, Petersson K, Hedegaard M, Ottesen B, Dykes AK, Henriksen TB, Damm P. Sports and leisure-time physical activity in pregnancy and birth weight: a population-based study. Scand J Med Sci Sports 2009; 20:e96-102. [PMID: 19422639 DOI: 10.1111/j.1600-0838.2009.00918.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We examined the association between sports and other leisure-time physical activities during pregnancy and birth weight of babies born after 37 completed weeks of gestation. All Danish-speaking pregnant women attending routine antenatal care at the Department of Obstetrics, Aarhus University Hospital, Denmark, from August 1989 to September 1991 were invited to participate in the study. A total of 4458 healthy women who delivered after 37 completed gestational weeks participated in this study. The associations between sports (0, 1-2, 3+ h/week) or leisure-time physical activity (sedentary, light, and moderate to heavy) and birth weight were examined by linear and logistic regression and adjusted for potential confounding factors such as smoking, parity, schooling, pre-pregnancy body mass index and gestational age. The results showed that pregnant women who practiced sports or were moderate to heavy leisure-time physical active during the early second or the early third trimester gave birth to infants with a similar birth weight as inactive women. The proportion of newborns with a low (<2500 g) or a high birth weight (>/=4500 g) was also unchanged. In conclusion, in this large population-based study, we found no association between sports and leisure-time physical activity and low-birth weight, high-birth weight, or average-birth weight.
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Affiliation(s)
- H K Hegaard
- The Unit of Caring Sciences, Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
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Low birth weight of contemporary African Americans: An intergenerational effect of slavery? Am J Hum Biol 2009; 21:16-24. [DOI: 10.1002/ajhb.20824] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Baciuk EP, Pereira RI, Cecatti JG, Braga AF, Cavalcante SR. Water aerobics in pregnancy: Cardiovascular response, labor and neonatal outcomes. Reprod Health 2008; 5:10. [PMID: 19025579 PMCID: PMC2613131 DOI: 10.1186/1742-4755-5-10] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Accepted: 11/21/2008] [Indexed: 12/16/2022] Open
Abstract
Background To evaluate the association between water aerobics, maternal cardiovascular capacity during pregnancy, labor and neonatal outcomes. Methods A randomized, controlled clinical trial was carried out in which 34 pregnant women were allocated to a water aerobics group and 37 to a control group. All women were submitted to submaximal ergometric tests on a treadmill at 19, 25 and 35 weeks of pregnancy and were followed up until delivery. Oxygen consumption (VO2 max), cardiac output (CO), physical fitness, skin temperature, data on labor and delivery, and neonate outcomes were evaluated. Frequency distributions of the baseline variables of both groups were initially performed and then analysis of the outcomes was carried out. Categorical data were compared using the chi-square test, and numerical using Student's t or Mann-Whitney tests. Wilk's Lambda or Friedman's analysis of repeat measurements were applied for comparison of physical capacity, cardiovascular outcomes and maternal temperature. Results VO2 max and physical fitness were higher in both groups in the second trimester, returning to basal levels in the third trimester. In both groups, CO increased as pregnancy progressed and peak exercise temperature was higher than resting temperature, increasing further after five minutes of recovery and remaining at this level until 15 minutes after exercise completion. There was no difference between the two groups regarding duration (457.9 ± SD 249.6 vs 428.9 ± SD 203.2 minutes) or type of delivery. Labor analgesia was requested by significantly fewer women in the water aerobics group (27% vs 65%; RR = 0.42 95%CI 0.23–0.77). Neonatal results were similar in both groups. Conclusion The regular practice of moderate water aerobics by sedentary and low risk pregnant women was not detrimental to the health of the mother or the child. There was no influence on maternal cardiovascular capacity, duration of labor or type of delivery; however, there were fewer requests for analgesia during labor in the water aerobics group.
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Affiliation(s)
- Erica P Baciuk
- Department of Obstetrics and Gynecology, University of Campinas, Sao Paulo, Brazil.
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Lewis B, Avery M, Jennings E, Sherwood N, Martinson B, Crain AL. The Effect of Exercise During Pregnancy on Maternal Outcomes: Practical Implications for Practice. Am J Lifestyle Med 2008. [DOI: 10.1177/1559827608320134] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The American College of Obstetricians and Gynecologists recommends that women with low-risk pregnancies participate in moderate-intensity exercise during their pregnancy. Currently, only 15.1% of pregnant women exercise at the recommended levels, which is significantly lower than the general population's 45%. One potential reason is that exercise during pregnancy is perceived as risky. In this article, the authors provide a critical review of the literature examining the effect of exercise on preeclampsia, gestational diabetes, weight gain, labor and birth, and other issues associated with pregnancy. Overall, the evidence indicates that exercise during pregnancy is safe and perhaps even reduces the risk of preeclampsia and gestational diabetes. The evidence for weight gain and labor and birth (rates of cesarean sections, duration of labor) is mixed. Unfortunately, much of the research examining exercise during pregnancy is observational, and the few randomized controlled trials that do exist are small and inadequately powered. Taken together, given the potential benefits of exercise during pregnancy and the lack of evidence for harmful effects on the mother and newborn, practitioners should encourage their healthy pregnant patients to exercise. Practical guidelines for recommending exercise to pregnant women are presented.
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Affiliation(s)
- Beth Lewis
- HealthPartners Research Foundation, Minneapolis, Minnesota,
| | | | | | - Nancy Sherwood
- HealthPartners Research Foundation, Minneapolis, Minnesota
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Schlüssel MM, Souza EBD, Reichenheim ME, Kac G. Physical activity during pregnancy and maternal-child health outcomes: a systematic literature review. CAD SAUDE PUBLICA 2008; 24 Suppl 4:s531-44. [DOI: 10.1590/s0102-311x2008001600006] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2007] [Accepted: 06/25/2007] [Indexed: 12/16/2022] Open
Abstract
A systematic literature review was conducted to investigate the effects of physical activity during pregnancy on selected maternal-child health outcomes. The search included articles published from 1980 to 2005 in the MEDLINE and LILACS databases using key words such as physical activity, physical exercise, pregnancy, and gestation. The methodological quality of 37 selected articles was evaluated. It appears to be a consensus that some light-to-moderate physical activity is not a risk factor and may even be considered a protective factor for some outcomes. However, some studies found an association between specific activities (e.g., climbing stairs or standing for long periods) and inadequate birth weight, prematurity, and miscarriage. Few studies found an association between physical activity and maternal weight gain, mode of delivery, or fetal development. Further research is needed to fill these gaps and provide guidelines on the intensity, duration, and frequency of physical activity during pregnancy.
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Factors related to exercise over the course of pregnancy including women's beliefs about the safety of exercise during pregnancy. Midwifery 2007; 25:430-8. [PMID: 18063253 DOI: 10.1016/j.midw.2007.03.002] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2006] [Revised: 02/16/2007] [Accepted: 03/01/2007] [Indexed: 11/22/2022]
Abstract
OBJECTIVE to explore pregnant women's exercise patterns across pregnancy, reported reasons for exercising or not exercising, beliefs about the safety of exercise during pregnancy and the association of those beliefs with the amount and intensity of exercise that women participated in. DESIGN a prospective questionnaire-based approach was implemented over three pregnancy time points 8 weeks apart, with retrospective pre-pregnancy data obtained at the first time point. SETTING participants were mailed questionnaires at 16-23-weeks pregnancy (T1), 24-31-weeks pregnancy (T2), and 32-38-weeks pregnancy (T3). PARTICIPANTS a total of 158 pregnant women participated. MEASUREMENTS at 16-23-weeks pregnancy women completed an Exercise Safety Beliefs Questionnaire in which they described their beliefs about the safety of low to medium exercise, high intensity exercise, gentle exercise, and weight bearing exercise. At T1, T2 and T3 reasons for exercising and not exercising were described, and participants maintained a 1-week exercise diary in which they recorded amount and intensity of physical activity. Physical symptoms experienced over time were also reported. FINDINGS the amount and intensity of exercise decreased over the course of pregnancy, with main reasons for not exercising including feeling tired or unwell, being too busy, and, particularly in late pregnancy, exercise being uncomfortable. Some women also reported safety concerns. Safety concerns predicted amount and/ or intensity of exercise. KEY CONCLUSIONS overall, most women had clear beliefs about what forms of exercise were safe or not safe during pregnancy. Women who rated gentle and low to medium exercise as unsafe reported engaging in less intense and fewer minutes of exercise. IMPLICATIONS FOR PRACTICE information and discussion about ways to exercise safely, enjoyably, and comfortably should be offered to pregnant women by health professionals in early pregnancy, when safety beliefs may impact on women's exercise patterns across pregnancy, and throughout pregnancy since the most appropriate forms of exercise may need to be modified over time.
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Duncombe D, Skouteris H, Wertheim EH, Kelly L, Fraser V, Paxton SJ. Vigorous exercise and birth outcomes in a sample of recreational exercisers: A prospective study across pregnancy. Aust N Z J Obstet Gynaecol 2006; 46:288-92. [PMID: 16866788 DOI: 10.1111/j.1479-828x.2006.00594.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined the question of whether vigorous exercise undertaken by recreational exercisers across pregnancy, defined in two ways, were associated with reduced infant birthweight and gestational age at birth. METHODS A prospective approach was implemented. A total of 148 pregnant women participated. Average intensity duration and frequency of vigorous exercise reported were examined and compared with two existing definitions of vigorous exercise. Participants completed questionnaires (including retrospective reports on 3 months prepregnancy) and an exercise diary at 16-23 weeks pregnancy, 24-31 weeks pregnancy and 32-38 weeks pregnancy, and at 7 to 14 days post-partum a birth outcomes questionnaire was completed. RESULTS There were no significant differences between exercise groups for birthweight and gestational age at birth. CONCLUSIONS There was no evidence that the intensity duration and frequency of vigorous exercise were associated with significant reductions in mean birth outcomes for the infants of women who participated in the study. Replication in a large, more diverse sample is recommended.
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Affiliation(s)
- Dianne Duncombe
- School of Psychological Science, La Trobe University, Melbourne, Victoria, Australia
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46
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Clapp JF. Influence of Endurance Exercise and Diet on Human Placental Development and Fetal Growth. Placenta 2006; 27:527-34. [PMID: 16165206 DOI: 10.1016/j.placenta.2005.07.010] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2005] [Revised: 07/24/2005] [Accepted: 07/25/2005] [Indexed: 11/18/2022]
Abstract
The delivery of oxygen and substrate to the maternal-fetal interphase is the major maternal environmental stimulus which either up- or down-regulates feto-placental growth. During pregnancy, sustained exercise sessions cause an intermittent reduction in oxygen and substrate delivery to the interphase that may exceed 50% during the exercise but, it is probable that regular bouts of sustained exercise or exercise training may improve oxygen and substrate delivery at rest. The type of maternal carbohydrate intake (low- versus high-glycemic sources) and food intake frequency also influence substrate availability through their effects on maternal blood glucose levels and insulin sensitivity. As a result, different exercise regimens and/or different types of carbohydrate intake modify feto-placental growth. The magnitude and direction of the effect is determined by their average 24-h effect on oxygen and substrate availability at different time-points in pregnancy. In general, exercise in early and mid pregnancy stimulates placental growth while the relative amount of exercise in late pregnancy determines its effect on late fetal growth. Low-glycemic food sources in the diet decrease growth rate and size at birth while high-glycemic food sources increase it. Thus, it may be possible to improve pregnancy outcomes in both healthy, low-risk women and a variety of high-risk populaces by simply modifying maternal physical activity and dietary carbohydrate intake during pregnancy.
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Affiliation(s)
- J F Clapp
- Department of Reproductive Biology, Department of Obstetrics and Gynecology, MetroHealth Medical Center Campus of Case Western Reserve University, Cleveland, OH 44109, USA.
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Pal BR, Hussein NR, Howlett A, Harun YE, Rajaratnam R. Protective medical legislation deficient knowledge of maternity (health and safety) rights for work-adjustment exists amongst flexible trainee doctors: is there a risk to maternal and foetal health? Eur J Obstet Gynecol Reprod Biol 2005; 127:79-87. [PMID: 16260078 DOI: 10.1016/j.ejogrb.2005.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2004] [Revised: 09/19/2005] [Accepted: 09/21/2005] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess awareness, identify knowledge source and evaluate uptake amongst doctors of "health and safety rights" (HSR) contained within the current European protective medical legislation for pregnant workers. STUDY DESIGN A descriptive cross-sectional pilot study, by a postal questionnaire during the period 1998-1999, targeted 97 UK doctors (West Midlands region) after their first pregnancy. RESULTS Of 67 respondents (response rate 73%), 41 (61%) were Registrars (SpR) and 25 (37%) SHOs: 80% work-schedules did not change during pregnancy. Only 11% (95% CI, 4-21%) of the doctors surveyed actually knew their maternity rights. 66.2% had no knowledge of maternity legislation; 80% of respondents had not taken up health and safety rights. Fifty-two percent (95% CI, 40-65%) reported maternal and neonatal complications. CONCLUSIONS In a self-selected group of flexible trainees following their first pregnancy, only one in five female doctors have adequate knowledge about the legislative "health and safety rights" of work-schedule adjustment. A combination of reasons may contribute to the low uptake of these rights. The question of whether or not poor knowledge and uptake of legislative rights may be detrimental towards pregnancy and neonatal complications requires a large prospective study. An improvement in the knowledge of current maternity legislation could occur by targeting all medical students, all doctors, postgraduate trainers and National Health Service (NHS) employers.
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Affiliation(s)
- B R Pal
- Department of Pediatrics, Worcester Acute Hospitals Trust, Alexandria Hospital, Redditch, UK.
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Boskovic R, Gargaun L, Oren D, Djulus J, Koren G. Pregnancy outcome following high doses of Vitamin E supplementation. Reprod Toxicol 2005; 20:85-8. [PMID: 15808790 DOI: 10.1016/j.reprotox.2005.01.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2004] [Revised: 12/15/2004] [Accepted: 01/01/2005] [Indexed: 02/01/2023]
Abstract
The recommended dose of Vitamin E in human pregnancy is 22-30 mg/day. High doses of Vitamin E (>or=400 IU/day) have been shown to attenuate or even prevent the damaging effect of ethanol and diabetes on the fetus in experimental animal models. The Motherisk program prospectively enrolled, and followed-up on, 82 pregnant women exposed to high doses (>or=400 IU/day) of Vitamin E during the first trimester of pregnancy. Pregnancy outcome was compared to a matched control group. The study group (n=82) was exposed to Vitamin E at doses ranging from 400-1200 IU/day. There was one pregnancy with major malformation (omphalocele) in study group. There was an apparent decrease in mean birth weight (3173+/-467 g) in Vitamin E group as compare to control (3417+/-565 g; P=0.0015); however, there were no significant differences in rates of live births, preterm deliveries, miscarriages and stillbirths. Therefore, it is concluded that consumption of high doses of Vitamin E during the first trimester of pregnancy does not appear to be associated with an increased risk for major malformations, but may be associated with decrease in birth weight.
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Affiliation(s)
- Rada Boskovic
- Department of Clinical Pharmacology, The Motherisk Program, The Hospital for Sick Children, 555 University Avenue, University of Toronto, Toronto, Ont., M5G 1X8, Canada
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Wolfe LA, Charlesworth SA, Glenn NM, Heenan AP, Davies GAL. Effects of Pregnancy on Maternal Work Tolerance. ACTA ACUST UNITED AC 2005; 30:212-32. [PMID: 15981789 DOI: 10.1139/h05-116] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This review summarizes current information on the tolerance of healthy pregnant women and their fetuses to acute strenuous exertion. Maximal aerobic power, expressed in L•min−1, is not significantly affected in women who maintain an active lifestyle, whereas values expressed in mlùkg−1ùmin−1 decline with advancing gestational age in relation to maternal/fetal weight gain. Efficiency during standard exercise testing and the ventilatory anaerobic threshold (Tvent) also appear to be unaffected by pregnancy, but the ability to utilize carbohydrate and exercise anaerobically during brief strenuous exercise may be reduced. Fetal responses to short strenuous exercise are usually moderate and revert to baseline values within approximately 30 min postexercise. Future studies should examine alveolar gas exchange kinetics at the start of exercise and during recovery from both moderate and strenuous exertion. Existing studies of the responses of pregnant women to prolonged exercise have focused primarily on substrate utilization and glucose homeostasis. Other maternal responses to prolonged exercise that should be examined include acid-base regulation, temperature regulation, fluid and electrolyte balance, and perception of effort. Fetal reactions should also be examined in relation to maternal responses. Until evidence-based, occupation-specific guidelines become available, it is recommended that pregnant women use the Joint SOGC/CSEP Clinical Practice Guideline: Exercise in Pregnancy and the Postpartum Period, published by the Society of Obstetricians and Gynaecologists of Canada and the Canadian Society for Exercise Physiology (2003). Key words: human gestation, maximal exercise, prolonged exercise, fetal well-being
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Affiliation(s)
- Larry A Wolfe
- School of Physical and Health Education, Queen's University, Kingston, Ontario, K7L 3N6
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Clapp JF. The effects of maternal exercise on fetal oxygenation and feto-placental growth. Eur J Obstet Gynecol Reprod Biol 2003; 110 Suppl 1:S80-5. [PMID: 12965094 DOI: 10.1016/s0301-2115(03)00176-3] [Citation(s) in RCA: 130] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Sustained bouts of maternal exercise during pregnancy cause an acute reduction in oxygen and nutrient delivery to the placental site. The decreased flow also initiates a slight fall in intervillous and fetal pO2 which initiates a fetal sympathetic response. This, coupled with hemoconcentration and improved placental perfusion balance, maintains fetal tissue perfusion and oxygen uptake. Exercise training during pregnancy (regular bouts of sustained exercise) increases resting maternal (and perhaps fetal) plasma volume, intervillous space blood volume, cardiac output and placental function. These changes buffer the acute reductions in oxygen and nutrient delivery during exercise and probably increase 24 h nutrient delivery to the placental site. Thus, the effect of any given exercise regimen on fetal growth and size at birth is dependent on the type, frequency, intensity and duration of the exercise as well as the time point in the pregnancy when the exercise is performed. Maternal carbohydrate intake is yet another modifying factor. Beginning a moderate exercise regimen increases both anatomic markers of placental function and size at birth while maintaining a rigorous exercise regimen throughout pregnancy selectively reduces growth of the fetal fat organ and size at birth. Likewise, decreasing exercise performance in late-pregnancy increases size at birth while increasing exercise performance decreases it. Finally, the infants born of exercising women who eat carbohydrates which elevate 24 h blood glucose levels are large at birth irrespective of exercise performance.
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Affiliation(s)
- James F Clapp
- Departments of Reproductive Biology, Obstetrics and Gynecology and the Schwartz Center for Metabolism and Nutrition, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA.
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